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Potentially inappropriate colonoscopies common among older patients
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Colonoscopies performed among patients aged 70 years or older may be inappropriate in almost 24% of cases, according to recent results.
In a retrospective cohort study, researchers evaluated claims data from 74,681 Medicare beneficiaries aged 70 years and older who underwent colonoscopies between October 2008 and September 2009 in Texas. The cohort also was compared with a random 5% nationwide sample of matched Medicare recipients (n=56,566). Early repeat procedures performed without clear indication among patients aged 70 to 75 years, and those performed contrary to US Preventive Services Task Force screening recommendations for patients aged 76 years and older, were considered potentially inappropriate.
Within the Texas data, 23.4% of colonoscopies were potentially inappropriate, including 9.9% of those performed in patients aged 70 to 75 years, 38.8% for patients aged 76 to 85 years and 24.9% for patients aged 86 years or older. The nationwide data indicated that 23.5% of colonoscopies were potentially inappropriate, with a range of 19.5% to 30.5% according to hospital referral region, compared with a range of 13.3% to 34.9% in Texas hospital service areas. Factors associated with a reduced risk for inappropriate colonoscopy via multivariate analysis included female sex, black race, the presence of three or more comorbidities and residing in a rural area.
Among 797 individual colonoscopists, a mean of 23.9% of procedures were potentially inappropriate, with significantly higher percentages among 73 physicians (range 28.7% to 45.5%) and significantly lower percentages among 119 (range 6.7% to 18.6%). Colonoscopists who performed more potentially inappropriate procedures were more likely to have graduated from US medical schools, perform a higher volume of colonoscopies per year, have graduated medical school before 1990, and also were more likely to be surgeons.
“It is impossible using claims data to determine whether any given colonoscopy procedure in a specific patient was appropriate or inappropriate,” the researchers wrote. “What claims data can provide is an analysis of patterns, of how the percentage of potentially inappropriate colonoscopies varies by physician and geographic region.
“Public education campaigns on appropriate screening colonoscopy may reduce unnecessary testing and increase available screening capacity for the at-risk population.”
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